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National Institute on Drug Abuse -  NIDA NOTES
Director's Column
Volume 12, Number 4
July/August 1997

NIDA Initiative Will Stimulate Improvements In Drug Abuse Treatment

NIDA Director, Dr. Alan I. Leshner

Over the years, researchers have amassed an impressive amount of scientific knowledge about the treatment of drug abuse and addiction. This research has clearly shown us that drug abuse treatment can reduce drug use, drug-related criminal behavior, and the health and social costs of drug abuse and addiction.

In addition, NIDA has funded the development of several new behavioral treatments for cocaine abuse that have shown good success in clinical trials. Family therapies for adolescents, contingency management approaches, and cognitive-behavioral therapies are now ready for use in treatment programs. In addition, clinics around the Nation are using medications such as methadone and the NIDA-developed LAAM (leva-alpha-acetyl-methadol) in combination with behavioral treatments to treat heroin addicts successfully. Developing an effective medication to treat cocaine addiction continues to be a major NIDA priority, and we have a number of promising compounds in our medications development pipeline.

NIDA's comprehensive Treatment Initiative will
be the catalyst for more effective drug
abuse treatments.

Despite advances such as these, we need to do more to reduce the ravages of drug abuse and addiction. Therefore, NIDA has launched a major Treatment Initiative to further improve the effectiveness of drug abuse treatment. This Institute-wide effort is being coordinated by NIDA's Division of Clinical and Services Research. A special subcommittee of NIDA's National Advisory Council on Drug Abuse is helping us focus the Initiative's priorities. Over the next few years, the Treatment Initiative will increase NIDA's treatment research and dramatically expand the dissemination of information about research-proven drug abuse treatments.

To increase the usefulness of NIDA's existing base of treatment knowledge, our comprehensive Initiative will sponsor a series of research workshops to bring together experts in different areas of treatment. These experts will evaluate existing addiction treatments and determine which treatments work best and how they work. They also will recommend additional research to develop new and more potent behavioral and pharmacological therapies. Ultimately, these efforts should expand the treatment options available to practitioners and enable them to select the right combination for their patients.

The NIDA National Advisory Council Subcommittee on the Treatment Initiative has urged increased emphasis on the development of new behavioral therapies, the transfer of effective behavioral therapies into practice, and the development of new pharmacological and behavioral treatments for methamphetamine abuse. The Initiative will address the first two of these priorities with a series of workshops on practical issues involved in behavioral therapies development and application. And, to meet the challenge of methamphetamine abuse, NIDA has called for expanded research to develop medications to treat abuse of psychomotor stimulants other than cocaine, particularly methamphetamine.

The Treatment Initiative also will expand health services research to get a clearer picture of how the organization, management, and financing of drug abuse treatment affect its accessibility, availability, costs, and results. This research will enable us to evaluate and further improve the effectiveness and cost-effectiveness of drug abuse treatment in the real world. In turn, these data will help us to respond successfully to ongoing changes in the delivery and financing of health care. We have already begun this process by issuing a new Request for Applications to encourage additional health services researchin these areas.

The Initiative will launch extensive information dissemination activities to address directly what I consider to be the greatest barrier to improving drug abuse treatment today - a general disbelief in the effectiveness of drug abuse treatment. I believe that this "great disconnect" between public perceptions and what science has shown - that drug abuse is clearly treatable - stems from general ignorance about these findings. Simply put, the public lacks knowledge about the biological and behavioral changes wrought by drug abuse and addiction and the success of treatment in addressing these changes. This lack of knowledge undermines our ability to treat this chronic, relapsing disease effectively. It also erodes support for the research we need to further improve drug abuse treatment.

To bridge this disconnect, the Treatment Initiative will spread the word that we have effective drug abuse treatments that work well for many people. In addition, the conferences, research symposia, and workshops that the Initiative will sponsor over the next few years will greatly increase the flow of scientific information about drug addiction and treatment issues among researchers, policymakers, the treatment community, and the general public. For example, all of these constituencies will be invited to a major treatment conference next April where treatment researchers will spotlight what we know about addiction and models of successful addiction treatment. Taken together, these coordinated activities will increase understanding of drug abuse treatment research. These activities will also demonstrate to the public, policymakers, and public and private agencies that funding drug abuse research and treatment is well worth the money. (For full details of activities that are being planned for the Treatment Initiative, see "NIDA Launches Drug Abuse Treatment Initiative.")

The news about drug abuse treatment is good news. Many studies have shown the effectiveness of drug abuse treatment. And we have the knowledge and the tools to develop drug abuse treatments that will work even better tomorrow. I firmly believe that NIDA's comprehensive Treatment Initiative will be the catalyst for more effective drug abuse treatments that will substantially alleviate the heavy individual, family, and societal costs and consequences of this terrible disease.

From NIDA NOTES, July/August 1997

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